47011 research outputs found
Sort by
European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) 2025 guidelines for surgical antimicrobial prophylaxis in dogs and cats
Get PDFSurgical antimicrobial prophylaxis involves the administration of antimicrobials to reduce the risk of a surgical site infection and represents a significant proportion of all antimicrobial use in cats and dogs. This evidence-based, European Network for Optimization of Veterinary Antimicrobial Therapy guideline provides recommendations for both peri- and post-operative surgical antimicrobial prophylaxis for a wide range of soft tissue and orthopaedic procedures performed in dogs and cats. A multidisciplinary panel developed the recommendations while adhering to the Grading of Recommendations Assessment, Development and Evaluation framework. The opinions of veterinary practitioners were incorporated to ensure applicability. Ten strong recommendations against, three conditional recommendations against and five conditional recommendations for the use of surgical antimicrobial prophylaxis were drafted by the panel. Strong recommendations against surgical antimicrobial prophylaxis were often informed by low- to very low-certainty evidence that treatment has no beneficial effect. However, the anticipated harmful effects of antimicrobial use are well established and offer an important counterbalance to unsubstantiated use. Conditional recommendations were made when there was a probable balance of effects in one direction, although appreciable uncertainty was present. The European Network for Optimization of Veterinary Antimicrobial Therapy guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document and the supporting systematic review to draft national or local guidance documents that support rational surgical antimicrobial prophylaxis
Epistemic injustice in psychiatric research and practice
Get PDFThis paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions
Efficacy and Toxicity Profile of Carboplatin/Gemcitabine Chemotherapy in Locally Advanced or Metastatic Biliary Tract Cancer: A Single UK Centre Experience
Get PDFBackground/Objectives: Biliary tract cancers (BTCs) refer to an invasive group of malignancies consisting of gallbladder cancer, ampullary cancer, and cholangiocarcinoma (CCA). BTCs are often diagnosed at advanced stages, leading to poor prognoses. While cisplatin-based chemotherapy remains the standard first-line treatment, carboplatin/gemcitabine serves as an alternative, particularly for patients with contraindications to cisplatin. This retrospective study evaluates the real-world efficacy and safety of carboplatin/gemcitabine in patients with advanced BTC who were ineligible for cisplatin-based treatment at a single UK centre. Methods: Data from 66 patients treated between March 2018 and July 2023 were analysed for overall survival (OS), progression-free survival (PFS), and toxicities. Results: The median OS was 8.97 months (95% CI: 6.78–11.16), and the median PFS was 5.88 months (95% CI: 4.78–6.98). Tumour control rate was achieved in 70% of cases. Patients receiving fewer than four chemotherapy cycles or presenting with poor baseline markers exhibited significantly worse survival outcomes (p < 0.05). Haematological toxicities were common, including thrombocytopenia (63.7%), neutropenia (48.5%), and anaemia (50.0%). Conclusions: While carboplatin/gemcitabine is a viable treatment for advanced BTC, larger trials are necessary to confirm its efficacy
The (non)enactment of intelligent accountability through stakeholder engagement: A micro-processual perspective
Get PDFThis paper examines the role of individual actions in shaping accountability relationships by adopting a micro-level perspective. Drawing on the concept of intelligent accountability, it presents a three-phase processual model to analyse the unfolding of a stakeholder engagement plan within a large firm. Despite the firm's president aiming to foster inclusion and participation, managers exhibited varied and often conflicting micro-actions during face-to-face stakeholder meetings. This misalignment led to an ‘intent-action paralysis,’ resulting in unintended relational consequences that hindered change and long-term stakeholder relationships. The study underscores the value of micro-processual analysis in advancing accountability and stakeholder engagement research, offering insights into their inherently relational dynamics. It contributes to the broader discussion on the challenges of enacting intelligent accountability, stakeholder engagement and the associated responsibilities
External and Internal Threats to the Freedom of Religion or Belief of Indigenous Peoples in Latin America
Get PDFIndigenous Peoples in Latin America face a dual challenge of social vulnerability and violations of freedom of religion or belief (FoRB). Representing 8% of the region’s population yet disproportionately affected by poverty, displacement, and health disparities, these communities also endure persistent religious discrimination—a challenge historically overlooked in policy and scholarship. This article advances the understanding of FoRB violations against Indigenous Peoples by distinguishing between external threats, targeting collective religious practices, and internal threats, undermining individual religious rights. Using a cross-case analysis of Paraguay, Mexico, and Colombia, this study illustrates the varied manifestations of these threats, relying on novel data from interviews, open-source platforms, and the Violent Incidents Database of the Observatory of Religious Freedom in Latin America and the International Institute for Religious Freedom. Focusing on Latin America as a “least likely case” for FoRB violations, the article highlights significant disparities in FoRB protections for Indigenous Peoples, challenging the assumption of Latin America as a region of relative religious freedom. By shedding light on these violations, the study underscores their broader implications for political stability and human rights. The findings call for greater attention to the intersections of religious freedom and Indigenous rights, offering a framework applicable to global contexts. This work also highlights the need for sustained data collection and targeted interventions to address these challenges effectively
A systematic review on the prevalence of tick-borne encephalitis virus in milk and milk products in Europe
Get PDFBackground: Tick-borne encephalitis virus (TBEV) is one of the most significant zoonotic diseases in Europe. It primarily spreads through the bites of infected ticks and, less frequently, through consumption of raw milk and dairy products from viremic domestic ruminants. Aims: Assess the prevalence of TBEV or anti-TBEV antibodies in milk and milk products from domestic ruminants in Europe. Materials and Methods: Systematic literature review adhering to the JBI methodology, and reported following the PRISMA framework. Results: From the 16 included scientific articles, we extracted 35 data collections (31 on raw milk and 4 on raw milk cheese); studies focused on cow (n = 15), goat (n = 11) and sheep milk (n = 5), goat (n = 3) and cow/goat cheese (n = 1). Fifteen data collections involved individual milk and 16 bulk milk samples. The estimated prevalence of TBEV in individual raw milk and cheese was 6% and 3%, respectively. TBEV prevalence in bulk milk was very heterogeneous, with most values either 0% or 100%. Discussion: Although published research on TBEV transmission to humans through milk and dairy products in the EU countries is limited, our results highlight the potential infection risk for consumers. The variable prevalence reported in the studies may reflect the focal nature of TBEV. Conclusion: Studies on unpasteurised dairy products from domestic ruminants can be valuable for the detection of TBEV presence in a geographic area, even when human cases are not reported. Thanks to the ease of sample collection, their testing could be adopted in monitoring plans on TBEV
Is NEWS2 the optimal evidence-based surveillance tool for all respiratory patients or does it just represent the beginning of an iterative development process?
Get PDFMedical practice is built on the foundations of evidence-based medicine. Hence, the more common the clinical intervention, the more comprehensive the evidence on which that intervention should be based. Although the widespread adoption of a national early warning score in the UK has led to improvements in the delivery of care, it should be considered as providing a foundation that can be refined and developed, and there is still a need for critical reflection and evaluation of early warning scores, particularly for individuals with chronic respiratory disease, in order to optimise patient monitoring, predict deterioration and guide intervention
Existing Knowledge Gaps in Risk Factors and Consequences of Lipohypertrophy in People Using Continuous Subcutaneous Insulin Infusion Therapy: A Systematic Review and Meta-analysis
Get PDFBackground:Lipohypertrophy is a common skin complication in individuals with insulin-treated diabetes, but this condition in those using insulin pumps (continuous subcutaneous insulin infusion, CSII) remains poorly understood. This study aimed to identify and summarize scientific evidence regarding the risk factors and clinical consequences of lipohypertrophy in people using CSII.Methods:Medical databases (MEDLINE/PubMed, Embase, CENTRAL) were searched to identify relevant studies published in English from 1990 to March 19, 2024. If possible, extracted data were cumulated in meta-analyses. This systematic review was registered on PROSPERO (CRD42024554127).Results:Nine studies reporting risk factors for lipohypertrophy or its consequences in people treated with CSII were identified. In the included studies, only individual risk factors were reported, which in most cases prevented the conduct of a meta-analysis. Meta-analyses could be performed for two factors, that is, improper cannula site rotation and male sex. The odds of developing lipohypertrophy were higher in individuals incorrectly rotating (prevalence odds ratio, pOR = 2.59 [95% Confidence interval, CI: 1.39-4.83]), whereas gender had no impact on the prevalence of lipohypertrophy (pOR = 1.13 [95% CI: 0.62-2.06]). Due to the limitations of the available data, it was not possible to draw conclusions about the clinical consequences of lipohypertrophy in people on CSII.Conclusions:This systematic review demonstrated that studies on the risk factors and clinical consequences of lipohypertrophy in CSII users are limited and that the currently published data are insufficient to draw definitive conclusions. There is a need for more comprehensive and well-designed clinical studies to better understand this issue in CSII users
Exploring community pharmacy and general practice views on primary care communication and pathways to access antibiotics in England
No full textBackgroundWith most antimicrobials in England being prescribed in primary care, collaboration on antimicrobial stewardship (AMS) between general practitioners (GPs) and community pharmacists (CPs) is important. Previous research identified barriers to communication between GPs and CPs across England.ObjectivesTo explore experiences of communication between GPs and CPs in relation to AMS and the pathways to access antibiotics in primary care.MethodsFive qualitative focus groups and nine semi-structured interviews were conducted with GP and community pharmacy professionals (CPPs) independently. Two reconvened focus groups with GPs and CPPs present together provided a holistic discussion on initial findings and practical solutions. Data were analysed thematically.ResultsNine CPs, three pharmacy technicians and 12 GPs participated. Four themes emerged: nature of GP–CP interactions, role recognition, barriers to AMS and overcoming barriers. Many CPs, particularly those not co-located with a GP surgery, reported challenges in contacting GPs. Proximity of location between CPs and GPs influences ease of communication and relationship management. GPs highlighted having limited or no awareness of the availability of medicines at the point of prescription. Suggested solutions to optimize collaborative working on AMS included providing functionality to share topline patient notes with prescriptions, a system that tracks and summarizes stock levels and having central points of contact between CPs and GPs.ConclusionThe challenges reported have implications on the collaborative relationship between GPs and CPs and solutions are needed to optimize AMS between primary care health professionals. The appetite for digital transformation suggests that strategic conversations with senior stakeholders are needed
Twelve tips for using phenomenology as a qualitative research approach in health professions education
Get PDFPhenomenology is a qualitative research approach that seeks to understand the individual meanings of lived experience. This 12 Tips article highlights the importance of understanding the philosophical foundations that inform the choice of phenomenological research study, including descriptive and interpretive phenomenology. The article provides a practical guide to the choice of the most appropriate phenomenological research approach and the process of data collection, iterative data analysis and interpretation, with consideration of the essential aspects of bracketing and reflexivity
Access Repository Dashboard
Do you manage Open Research Online? Become a CORE Member to access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard! 👇